D. Elizabeth Jesse

Effects of Spirituality and Psychosocial Well-Being on Health Risk Behaviors in Appalachian Pregnant Women

OBJECTIVE To determine the relationships of spirituality and psychosocial well-being to health risk behaviors in pregnant Appalachian women. METHOD Descriptive study of 120 women between 16 and 28 weeks of pregnancy. The instruments used were the Spiritual Perspective Scale and religiosity items from the Jarel Well-Being Scale. Psychosocial well-being was measured by the Prenatal Psychosocial Profile. Four items measured health risk behaviors. RESULTS Higher levels of spirituality (spiritual perspective and religiosity) were significantly correlated with greater satisfaction with social support, higher levels of self-esteem, and decreased levels of smoking. Sociodemographic, psychosocial, and spiritual variables explained 25% of the variance in frequency of smoking, and in the logistic regression analysis, psychosocial stress was the only variable that significantly predicted substance use. CONCLUSION Higher levels of spirituality and lower levels of stress are associated with decreased health risk behaviors among pregnant women from Appalachia. Increasing spiritual resources and decreasing stress during pregnancy offer the potential to improve health promotion efforts in pregnancy with women from Appalachia.

Barriers to seeking help and treatment suggestions for prenatal depressive symptoms: focus groups with rural low-income women.

Interviews were conducted with 21 pregnant or recently pregnant African American and Caucasian low-income women living in a rural southeastern community to elicit perceived barriers to seeking help for depressive symptoms in pregnancy and ways to overcome these barriers, as well as intervention suggestions. Participants identified themes regarding barriers to seeking help. These were: (1) lack of trust, (2) judgment/stigma, (3) dissatisfaction with the health care system, and (4) not wanting help. Themes identified regarding overcoming barriers were: (1) facilitating trust and (2) offering support and help. These and other findings point to the importance of integrating womens ideas into culturally sensitive interventions for women with depressive symptoms or depression in pregnancy that can be provided by a psychiatric nurse-practitioner or other mental health provider.

Risks and resources associated with antepartum risk for depression among rural southern women.

Background: Seven to 13% of American women who are pregnant suffers from major depression and 11%-50% experience antepartum depressive symptoms. Objective: To examine the prevalence of depressive symptoms in pregnancy and examine the biopsychosocial-spiritual risks and resources in low-income women of diverse racial/ethnic groups. Methods: Prenatal interviews were conducted at 16-28 weeks gestation with 324 pregnant women from rural prenatal clinics in the southeastern United States; 43% were African American, 31% were Caucasian, and 26% were Hispanic. Multivariate logistic regression tested the contributions of psychosocial risks and psychosocial and spiritual resources to risk for depression (Beck Depression Inventory-II scores ≥16) for the aggregate and for each racial-ethnic group. Results: Beck Depression Inventory-II scores indicating risk for depression were found in 33% of the women. There were no significant differences in symptom rates among African Americans, Caucasians, and Hispanics (37%, 25%, and 36%, respectively). African American race, abuse, more stress, less social support, less self-esteem, and less spirituality were associated with risk for depression, controlling for sociodemographic factors. Discussion: A third of this diverse group of rural low-income women were at risk for depression in pregnancy. It is vital to screen for depressive symptoms in pregnancy and to identify psychosocial risks and resources associated with risk for depression in order to develop interventions for pregnant women with depressive symptoms.

The Effect of Faith or Spirituality in Pregnancy A Content Analysis

This study used a qualitative descriptive research design to discover the relevance and meaning of spirituality in the lives of 130 urban low-income pregnant women by asking the open-ended question, “How does your faith or spirituality affect your pregnancy if at all?” Forty-seven percent of the women in this study described how spirituality affected their pregnancy positively, 45% described that spirituality did not affect them, and 5.4% were unsure. A content analysis of those who answered positively revealed six themes from the data describing the meaning of faith or spirituality in pregnancy: (a) guidance and support; (b) protection, blessing, or reward; (c) communication with God; (d) strength and confidence; (e) help with difficult moral choices; and (f) a generalized positive effect. These findings point to the importance of attending to spirituality as a resource in pregnancy for those who value it and further exploring the meaning of spirituality in pregnancy.

Social Support and Self‐Esteem as Mediators Between Stress and Antepartum Depressive Symptoms in Rural Pregnant Women

The purpose of this secondary analysis was to determine whether satisfaction with social support and self-esteem mediated the relationship between antepartum stress and depressive symptoms in women attending prenatal clinics in a rural Southeastern community (N = 318). Path analysis with linear regression indicated that the relationship between antepartum stress and depressive symptoms was partially mediated by higher levels of the internal resources of satisfaction with social support and self-esteem. Self-esteem had a greater influence on the relationship between antepartum stress and depressive symptoms than did satisfaction with social support. These findings suggest further study to determine whether developing culturally tailored interventions that emphasize stress reduction activities in addition to enhancing self-esteem and increasing satisfaction with social support can decrease the burden of antepartum depressive symptoms in rural low-income women.

Prenatal Psychosocial Needs: Differences Between a TennCare Group and a Privately Insured Group in Appalachia

The purpose of this study was to determine the prenatal psychosocial needs of a group of women enrolled in TennCare, a Medicaid managed care program designed to cover all otherwise uninsured people in Tennessee, and compare them with privately insured women. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between 14 and 44 years of age and 16 to 28 weeks gestation at three prenatal clinics in East Tennessee. Chi-square analysis revealed that the TennCare enrollees in East Tennessee were significantly more likely to report higher psychosocial needs in pregnancy than the privately insured group. Women enrolled in TennCare had a significantly higher incidence of physical abuse, depressive symptoms, and smoking than the privately insured group. Pregnancy provides a window of opportunity for assessing and intervening with vulnerable women enrolled in Medicaid managed care who report psychosocial problems.

A Pilot Study to Reduce Risk for Antepartum Depression Among Women in A Public Health Prenatal Clinic

This pilot study evaluated the feasibility, effectiveness, and helpfulness of Insight-Plus, a brief culturally-tailored cognitive behavioral intervention for African-American and Caucasian rural low-income women at risk for APD [Edinburgh Postnatal Depression Scale (EPDS) ≥10]. Forty two percent (63/149) of women in this non-randomized study were at risk for APD and 41% (26/63) of women, who met all eligibility criteria, initially agreed to participate. Seventeen participants completed all six intervention sessions. Ninety-four percent (16/17) who completed their one-month post-intervention interviews had an antepartum recovery rate of 81% (13/16, EPDS ≤10). Participants reported that many aspects of the program were helpful and they continued to use the intervention exercises after the sessions ended.

Performance of a Culturally Tailored Cognitive-Behavioral Intervention Integrated in a Public Health Setting to Reduce Risk of Antepartum Depression: A Randomized Controlled Trial

INTRODUCTION Cognitive-behavioral group interventions have been shown to improve depressive symptoms in adult populations. This article details the feasibility and efficacy of a 6-week, culturally tailored, cognitive-behavioral intervention offered to rural, minority, low-income women at risk for antepartum depression. METHODS A total of 146 pregnant women were stratified by high risk for antepartum depression (Edinburgh Postnatal Depression Scale [EPDS] score of 10 or higher) or by low-moderate risk (EPDS score of 4-9) and randomized to a cognitive-behavioral intervention or treatment as usual. Differences in mean change of EPDS and Beck Depression Inventory (BDI)-II scores for low-moderate and high-risk women in the cognitive-behavioral intervention and treatment as usual for the full sample were assessed from baseline (T1), posttreatment (T2), and one-month follow-up (T3), and for African American women in the subsample. RESULTS Both the cognitive-behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3. In women at high risk for depression (n = 62), there was no significant treatment effect from T1 to T2 or T3 for the EPDS. However, in low-moderate risk women, there was a significantly greater mean change in the BDI-II scores from significant decrease in the BDI-II scores from T1 to T2 (4.92 vs 0.59, P = .018) and T1 to T3 (5.67 vs 1.51, P = .04). Also, the cognitive-behavioral intervention significantly reduced EPDS scores for African American women at high risk (n = 43) from T1 to T2 (5.59 vs 2.18, P = .02) and from T1 to T3 (6.32 vs 3.14, P = .04). DISCUSSION A cognitive-behavioral intervention integrated within prenatal clinics is feasible in this sample, although attrition rates were high. Compared to treatment as usual, the cognitive-behavioral intervention reduced depressive symptoms for African American women at high risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression. These promising findings need to be replicated in a larger controlled clinical trial that incorporates methods to maintain greater participant engagement.

Catching the Spirit of Cultural Care: A Midwifery Exemplar

Midwives provide an integral part of health care in underserved, rural areas of the United States. To meet the health care needs of people from diverse cultures, they need to learn culturally competent care. This article describes efforts by a university and its college of nursing to adapt to a changing cultural climate and prepare faculty and students to become culturally competent in practice encounters with diverse populations. Culturally competent care is infused in the midwifery curriculum through self-directed inquiry and discovery approaches. Outcomes of these approaches are evident in the nurse-midwifery program, which can serve as a model for integration of culturally competent care throughout the nursing curriculum.

Reusable learning units: an innovative teaching strategy for online nursing education.

Constructivist and adult learning theory provided the theoretical framework for reusable learning units (RLUs) developed for a Southeastern Universitys family nurse-practitioner and nurse-midwifery distance educational programs. Reusable learning units are an organized series of learning events that satisfy one or more interrelated learning objectives that cannot be broken down to component parts without losing semantic and pragmatic meaning. This paper describes the conceptual framework, background and history of RLUs, and collaborative efforts for development and implementation.